Perfusion regulation

ABSTRACT

A system and method for regulating cooperatively the pressures and flows of input vessels such as both the portal vein and hepatic artery for the liver. This invention solves problems of less-than-therapeutic portal vein flow during perfusion preservation by implementing cooperative regulation between the inputs, e.g., portal vein and hepatic artery pumping systems, on an organ preservation apparatus. It includes an algorithm that adapts to the situation wherein the portal vein has reached minimum flow and maximum pressure. The cooperative regulation algorithm senses the problem with the portal vein and solves it by adjusting the hepatic artery flow conditions.

TECHNICAL FIELD

This disclosure is directed to methods and systems for perfusing, in adefined and controlled manner, one or more organs, tissues or the like(hereinafter “organs”) to sustain, maintain or improve the viability ofthe organs.

BACKGROUND

Perfusion apparatus for transplantable organs are described in thescientific and patent literature. For example, U.S. Pat. No. 6,977,140,assigned to Organ Recovery Systems, Inc., which is hereby incorporatedby reference herein in its entirety, describes such an apparatus. U.S.Pat. No. 6,977,140 does not, however, address certain aspects ofperfusing a multi-inflow organ, such as a human liver.

Ideally organs are harvested in a manner that limits their warm ischemiatime. Unfortunately, many organs, especially from non-beating heartdonors, are harvested after extended warm ischemia time periods, e.g.,45 minutes or more. Machine perfusion of these organs at low temperatureis preferable (Transpl Int 1996 Daemen). Further, low temperaturemachine perfusion of organs at low pressures is also preferable(Transpl. Int 1996 Yland). Roller or diaphragm pumps are often used todeliver perfusate at controlled pressures. Numerous control circuits andpumping configurations are used to achieve preferable perfusionconditions. See, for example, U.S. Pat. Nos. 5,338,662 and 5,494,822 toSadri; U.S. Pat. No. 4,745,759 to Bauer et al.; U.S. Pat. Nos. 5,217,860and 5,472,876 to Fahy et al.; U.S. Pat. No. 5,051,352 to Martindale etal.; U.S. Pat. No. 3,995,444 to Clark et al.; U.S. Pat. No. 4,629,686 toGruenberg; U.S. Pat. Nos. 3,738,914 and 3,892,628 to Thorne et al.; U.S.Pat. Nos. 5,285,657 and 5,476,763 to Bacchi et al.; U.S. Pat. No.5,157,930 to McGhee et al.; and U.S. Pat. No. 5,141,847 to Sugimachi etal.

Use of the above described pumps for machine perfusion of organs,however, may introduce a risk of under- or over-pressurization of theorgan. High pressure perfusion, above about 60 mm Hg, for example, canwash off the vascular endothelial lining of the organ and damage organtissue. In particular, at hypothermic temperatures, an organ does nothave neurological or endocrinal connections to protect itself bydilating its vasculature under high pressure. Low pressure perfusion mayprovide insufficient perfusate to the organ resulting in organ failure.

This concern over precise control is particularly acute in multi-infloworgans. In the living liver, blood flows into the organ via the portalvein and the hepatic artery. The blood combines in the sinusoids of theliver, and then flows out through the hepatic vein. In vivo, the hepaticartery receives relatively higher pressure arterial blood (ca. 100mmHg), while the portal vein receives relatively lower pressure venialblood (ca. 18 mmHg). A system of vascular tension and sphinctersregulates the relative resistance of blood through the portal vein andhepatic artery to manage proper flow from each inflow port into thesinusoids despite the unequal initial pressures.

During organ perfusion preservation, a goal is to perfuse fluids throughthe vessels of the ex vivo liver (1) in sufficient volume, i.e., flow,to enable proper dilution of waste products and proper provision ofnutrients; and (2) at sufficient pressure to maintain vessel patencywhile limiting maximum flow and pressure to avoid damage. In a singleinflow organ like the kidney, for example, this often is achieved simplyby regulating the pressure and flow into the single inflow artery withinwell-defined minimum and maximum pressure and flow therapeutic windows.Regulation methods for single inflow organs are well known.

Conventionally, flow regulation into a liver is treated just as in akidney. The portal vein pressure and the hepatic artery pressure, andrespectives flows, are separately and independently maintained withinwell-defined therapeutic windows between maximum and minimum levels,regulated to a constant level of pressure or flow, or a combination ofboth. Methods of separate and independent regulation of portal andhepatic pressure and flow are well known.

SUMMARY

A need exists for a method and system for perfusing an organ at adefined and/or controlled pressure that can take into account organresistance, i.e., pressure/flow, to avoid damage to the organ and tomaintain the organ's viability.

This disclosure is directed to methods and systems for cooperativelyregulating pressures and flows of different input vessels of an organ,such as the portal vein and hepatic artery for a liver. Studiesidentified a phenomenon in isolated liver perfusion in which increasingflow through the hepatic artery is associated with a consequentdecreasing flow through the portal vein under constant perfusionpressure, i.e., pressure-regulated, conditions. These studies revealedthat the portal vein flow may decrease to a level that is below theminimum therapeutic window as the hepatic flow increases.

Disclosed methods and systems seek to address, among other objectives,problems of less-than-therapeutic portal vein flow during organperfusion preservation by implementing cooperative regulation betweenthe inputs, e.g., portal vein and hepatic artery pumping systems, on anorgan perfusion preservation apparatus. These methods and systems mayinclude a control algorithm that responds when conditions in the portalvein are detected to reach minimum flow and maximum pressure asmeasurable parameters. In such instances, the flow cannot be increasedby increasing the pressure and the pressure cannot be reduced bydecreasing the flow. These conditions may be resolved by implementing acooperative control algorithm that is provided with a sensor input ofthe problem condition within the portal vein, and cooperatively adjustshepatic artery flow conditions. For example, the control algorithm mayreduce the hepatic artery flow, maintaining it within the hepatic arterytherapeutic window, enabling the portal vein flow to return to withinthe therapeutic window.

In an organ perfusion apparatus, gross organ perfusion pressure may beprovided by a pneumatically pressurized medical fluid reservoircontrolled by a computer. The computer may be programmed to respond toan input from a sensor or similar device, for example, disposed in aflow path such as in an end of tubing placed in a vessel of the perfusedorgan. The computer may be used in combination with a stepping motor/camvalve or pinch valve to (1) enable perfusion pressure fine tuning, (2)prevent overpressurization, and/or (3) provide emergency flow cut-off inthe vessel. Alternatively, the organ may be perfused directly from acomputer controlled pump, such as a roller pump or a peristaltic pump,with proper pump control and/or sufficient fail-safe controllers toprevent overpressurization of the organ, especially as a result of asystem malfunction. Substantially eliminating overpressurizationpotential may reduce the consequent potential damage to the vascularendothelial lining, and to the organ tissue in general, and mitigate theeffects of flow competition and flow extinction in a lower pressurevessel.

Further embodiments of the control algorithm may accommodate errorrecognition and alarm response to aberrant conditions. Such conditionsmay include when the portal flow and the hepatic pressure are bothreduced below the respective therapeutic windows, or when the portalvein or the hepatic vein is occluded.

Further embodiments may recognize that the vascular sphincters mayoperate in an on-off fashion and exhibit hysteresis in their on-off (oropen-closed) pressure thresholds. As a consequence, sequencing ofestablishment of portal flow versus hepatic flow may become significant.For example, if higher pressure hepatic artery perfusion is establishedfirst, then the sphincters controlling the portal vein flow into thesinusoids may become closed and require an opening pressure above theportal vein pressure. If this happens, the portal flow downstream ofthat particular sphincter would cease and the tissue fed by that vesselwould be properly perfused.

Embodiments may recognize the action of the sphincters and implement acontrol algorithm that establishes a sequence of portalvein-before-hepatic artery flow. This sequence recognizes that the organperfusion apparatus may undergo numerous startings and stoppings of flowto accommodate bubble purging, fault recovery, drug dosing, organadjustments and other effects. Some of these events are described in theabove-enumerated patent disclosures.

An organ diagnostic apparatus may also be provided to produce diagnosticdata such as an organ viability index. The organ diagnostic apparatusmay include features of an organ perfusion apparatus, such as sensorsand temperature controllers, as well as cassette interface features. Theorgan diagnostic apparatus may provide analysis of input and outputfluids in a perfusion system. Typically, the organ diagnostic apparatusis a simplified perfusion apparatus providing diagnostic data in asingle pass, in-line perfusion.

Disclosed embodiments may also provide an organ cassette that allows anorgan to be easily and safely moved between apparatus for perfusing,storing, analyzing and/or transporting the organ. The organ cassette maybe configured to provide uninterrupted sterile conditions and efficientheat transfer during transport, recovery, analysis and storage,including transition between the transporter, perfusion apparatus and/ororgan diagnostic apparatus, and/or other apparatus.

Disclosed embodiments may also provide an organ transporter that allowsfor transportation of an organ, particularly over long distances. Theorgan transporter may include features of an organ perfusion apparatus,such as sensors and temperature controllers, as well as organ cassetteinterface features.

Disclosed embodiments of the perfusion apparatus, transporter, cassette,and organ diagnostic apparatus may be networked to permit remotemanagement, tracking and monitoring of the location and therapeutic anddiagnostic parameters of the organ being stored or transported.Information systems may be used to compile historical data of organtransport and storage, and provide cross-referencing with hospital andUnited Network for Organ Sharing (UNOS) data on the donor and recipientfor the organ. The information systems may also provide outcome data toallow for ready research of perfusion parameters and transplantoutcomes.

These and other features and advantages of the disclosed methods andsystems are described in, or apparent from, the following detaileddescription of various exemplary embodiments.

BRIEF DESCRIPTION OF THE DRAWINGS

Various exemplary embodiments of disclosed methods and systems for aperfusion apparatus for implementing a control algorithm will bedescribed, in detail, with reference to the following drawings wherein:

FIG. 1 illustrates an organ perfusion apparatus according to thisdisclosure;

FIG. 2 is a schematic diagram of the apparatus of FIG. 1;

FIG. 3 is a diagram of a microprocessor controller which may beintegrated with the apparatus of FIG. 2, the organ cassette of FIG. 4D,and/or the organ transporter of FIG. 9;

FIGS. 4A-4D are perspective views of various embodiments of an organcassette according to the invention;

FIG. 5 is a schematic diagram of an organ perfusion apparatus configuredto simultaneously perfuse multiple organs;

FIGS. 6A and 6B illustrate an alternate embodiment of an organ cassetteaccording to this disclosure;

FIG. 7 shows an exterior perspective view of an organ transporteraccording to the present invention;

FIG. 8 is a cross-sectional view of the organ transporter of FIG. 7;

FIG. 9 is an alternative cross-sectional view of the organ transporterof FIG. 7;

FIG. 10 is a schematic diagram of the relationship between the pressureand flow of the fluids in the hepatic artery and portal vein of a liver;

FIG. 11 illustrates a perfusion apparatus adapted to execute thedisclosed control algorithm; and

FIG. 12 is a flow chart of a method for executing the disclosed controlalgorithm.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

For a general understanding of the features of the invention, referenceis made to the drawings. In the drawings, like reference numerals havebeen used throughout to designate like elements.

Disclosed systems and methods are involved in transport, storage,perfusion and diagnosis of organs. However, the disclosed systems andmethods may have other applications, and thus should not be construed tobe limited to particular contexts of use. Various disclosed features maybe particularly suitable for use in the context of, and in conjunctionand/or connection with the features of the apparatus and methodsdisclosed in U.S. patent application Ser. No. 09/162,128 (nowabandoned), U.S. Pat. Nos. 6,977,140 and 6,673,594, and U.S. PatentApplication Publications Nos. 2004-0248281, 2004-0221719, and2004-0111104, the disclosures of which are hereby incorporated byreference herein in their entirety.

FIG. 1 illustrates an organ perfusion apparatus 1. FIG. 2 is a schematicillustration of the apparatus 1 of FIG. 1. The apparatus 1 may be atleast partially microprocessor controlled, and pneumatically actuated. Amicroprocessor 150 with connections to sensors, valves, thermoelectricunits and pumps of apparatus 1 is schematically depicted in FIG. 3.Microprocessor 150 and apparatus 1 may be configured to be furtherconnected to a computer network to provide data sharing, for example,across a local area network or across the Internet.

The apparatus 1 may be capable of perfusing one or more organssimultaneously, at both normothermic and hypothermic temperatures. Allmedical fluid contact surfaces may be formed of, or coated with,materials compatible with the medical fluid used, more preferablynon-thrombogenic materials. As shown in FIG. 1, the apparatus 1 mayinclude a housing 2 that includes front cover 4, which may betranslucent, and a reservoir access door 3. The apparatus 1 may includeone or more control and display areas 5 a, 5 b, 5 c, 5 d for monitoringand controlling perfusion.

As schematically shown in FIG. 2, enclosed within the housing 2 is areservoir 10 that may include multiple reservoir tanks such as thedepicted three reservoir tanks 15 a, 15 b, 17. Reservoir tanks, depictedas 15 a, 15 b, may be standard one liter infusion bags, each with arespective pressure cuff 16 a, 16 b. A pressure source 20 may beprovided for pressurizing the pressure cuffs 16 a, 16 b. The pressuresource 20 may be pneumatic and may include an onboard compressor unit 21supplying external cuff activation via gas tubes 26, 26 a, 26 b, asshown in FIG. 2. Disclosed embodiments, however, are not limited to useof an onboard compressor unit as any adequate pressure source can beemployed. Other available pressures sources may include a compressed gas(e.g., air, CO₂, oxygen, nitrogen, etc.) tank (not shown).Alternatively, an internally-pressurized reservoir tank (not shown) maybe used. Reservoir tanks 15 a, 15 b, 17 may, in embodiments, be bottlesor other suitably rigid reservoirs that can supply perfusate by gravityor can be pressurized by compressed gas.

Gas valves 22 and 23 may be provided on gas tube 26 to allow for controlof the pressure provided by the onboard compressor unit 21.Anti-backflow valves 24 a, 24 b may be provided respectively on gastubes 26 a, 26 b. Pressure sensors P1, P2, P3, P4, P5, and P6 may beprovided to relay detected pressure conditions to the microprocessor150, shown in FIG. 3. Corresponding flow sensors (not shown) may also beprovided. The perfusion, diagnostic and/or transporter apparatus may beprovided with sensors to monitor perfusion fluid pressure and flow inthe particular apparatus to detect faults in the particular apparatus,such as pressure elevated above a suitable level for maintenance of theorgan. Gas valves GV₁ and GV₂ may be provided to release pressure fromthe cuffs 16 a, 16 b. One or both of gas valves GV₁ and GV₂ may bevented to the atmosphere. Gas valve GV₄ in communication with reservoirtanks 15 a, 15 b via tubing 18 a, 18 b may be provided to vent air fromthe reservoir tanks 15 a, 15 b through tubing 18. Tubing 18, 18 a, 18 b,26, 26 a and/or 26 b may be configured with filters and/or check valvesto prevent biological materials from entering the tubing or fromproceeding along the fluid path. The check valves and/or filters may beused to prevent biological materials from leaving one organ perfusiontubeset and being transferred to the tubeset of a subsequent organ in amultiple organ perfusion configuration. The check valves and/or filtersmay also be used to prevent biological materials, such as bacteria andviruses, from being transferred from organ to organ in subsequent usesof the perfusion apparatus in the event that such biological materialsremain in the perfusion apparatus after use. The check valves and/orfilters may be provided to prevent contamination problems associatedwith reflux in the gas and/or vent lines. For example, the valves may beconfigured as anti-reflux valves to prevent reflux. The third reservoirtank 17 is preferably pressurized by pressure released from one of thepressure cuffs via gas valve GV₂.

The medical fluid may be a natural fluid, such as blood, or otherwisesynthetic fluid, which may, for example, be a simple crystalloidsolution, or may be augmented with an appropriate oxygen carrier. Theoxygen carrier may, for example, be washed, stabilized red blood cells,cross-linked hemoglobin, pegolated hemoglobin or fluorocarbon basedemulsions. The medical fluid may also contain antioxidants known toreduce peroxidation or free radical damage in the physiologicalenvironment and specific agents known to aid in organ protection. Anoxygenated, e.g., cross-linked hemoglobin-based bicarbonate, solutionmay be preferred for a normothermic mode while a non-oxygenated, e.g.,simple crystalloid solution preferably augmented with antioxidants,solution may be preferred for a hypothermic mode. The specific medicalfluids used in both the normothermic and hypothermic modes may bedesigned or selected to reduce or otherwise prevent the washing away of,or damage to, the vascular endothelial lining of the organ. For ahypothermic perfusion mode, as well as for flush and/or static storage,a preferred solution is disclosed in U.S. Pat. No. 6,492,103, thedisclosure of which is hereby incorporated herein by reference in itsentirety. Examples of additives which may be used in perfusion solutionsare also disclosed in U.S. Pat. No. 6,046,046 to Hassanein, thedisclosure of which is hereby incorporated by reference herein in itsentirety. Other suitable solutions and materials may be used.

The medical fluid within reservoir 10 may be brought to a predeterminedtemperature by a first thermoelectric unit 30 a in heat transfercommunication with the reservoir 10. A temperature sensor T3 may relaythe temperature within the reservoir 10 to the microprocessor 150, whichadjusts some in turn the thermoelectric unit 30 a to maintain a desiredtemperature within the reservoir 10 and/or display the temperature on acontrol and display area such as 5 a for manual adjustment.Alternatively, or in addition, particularly where the organ perfusiondevice is going to be transported, the medical fluid within thereservoir 10 can be cooled utilizing a cryogenic fluid heat exchangerapparatus such as that disclosed in U.S. Pat. No. 6,014,864, thedisclosure of which is hereby incorporated by reference herein in itsentirety.

An organ chamber 40 may be provided which supports a cassette 65, asshown in FIG. 2. The cassette 65 may be configured to hold an organ tobe perfused. Otherwise the organ chamber 40 may support a plurality ofcassettes 65, as shown in FIG. 5, which may be disposed one adjacent theother. Various embodiments of the cassette 65 are shown in FIGS. 4A-4D.The cassette 65 may be formed of a material that is light but durable sothat the cassette 65 is highly portable. The material may also betransparent to allow visual inspection of the organ.

FIG. 4A illustrates a cassette 65 that holds an organ 60 to be perfused.The cassette 65 may include side walls 67 a, a bottom wall 67 b and anorgan supporting surface 66. The organ supporting surface 66 may beformed of a porous, perforated or mesh material to allow fluids to passthrough. The cassette 65 may also include a top 67 d and may be providedwith one or more openings 63 for tubing (see, for example, FIG. 4D). Theopenings 63 may include seals 63 a, e.g., septum seals or o-ring sealsand optionally be provided with plugs (not shown) to preventcontamination of the organ 60 and maintain a sterile environment. Also,cassette 65 may be provided with a closeable and/or vent 61 (see, forexample, FIG. 4D). Additionally, the cassette 65 may be provided withtubing for connection to the organ 60 and/or to remove medical fluidfrom an organ bath, and one or more connection devices 64 for connectingthe tubing to, for example, tubing 50 c, 81, 82, 91 and/or 132 (see, forexample, FIG. 4D) of an organ storage, transporter, perfusion and/ordiagnostic apparatus.

Vent 61 may include a filter device, and provide for control and/orequalization of pressure within the cassette 65 without contamination ofthe contents of the cassette 65. For example, organs are frequentlytransported by aircraft, in which pressure changes are the norm. Evenground transportation can involve pressure changes as motor vehiclespass through tunnels, over mountains, etc. In addition, one or more lids410 and 420 of cassette 65 can create an airtight seal with the cassette65. This air tight seal can create a pressure difference between theinside and outside of cassette 65. It may be desirable to provide forpressure equalization of the cassette 65 under such circumstances.However, free flow of air to achieve pressure equalization mightintroduce contaminants into the cassette 65. Thus, a vent 61 including afilter may be provided to allow the air flow without permittingintroduction of contaminants into the cassette 65.

The filter may facilitate clean air passing in both directions, whilerestricting dirt, dust, liquids and other contaminants from passing. Thepore size of the filter can be selected to prevent bacteria frompassing.

A pressure control valve (not shown) may optionally be associated withvent 61 as well. Such a valve may be configured and controlled torestrict the rate at which external pressure changes are transmitted tothe inside of the cassette 65, or even to prevent pressure increasesand/or decreases, as desired.

The cassette 65, and/or the organ supporting surface 66, openings 63,tubings and/or connection device 64, may be specifically tailored to thetype of organ and/or size of organ to be perfused. Flanges 67 c of theside support walls 67 a may be used to support the cassette 65 disposedin an organ storage, transporter, perfusion and/or diagnostic apparatus.The cassette 65 may further include a handle 68 that allows the cassette65 to be easily handled, as shown, for example, in FIGS. 4C and 4D. Eachcassette 65 may also be provided with its own mechanism, e.g., steppingmotor/cam valve 75 (for example, in the handle portion 68, as shown inFIG. 4C) for fine tuning the pressure of medical fluid perfused into theorgan 60, as discussed in more detail below. Alternatively, or inaddition, pressure may, in embodiments, be controlled by way of amicroprocessor 150, as shown in FIG. 3, which may receive pressuresensor data from pressure sensor P1. Likewise, flow sensors may becontrolled in a similar manner.

FIGS. 6A-6B illustrate an alternate embodiment of cassette 65. In FIG.6A, cassette 65 is shown with tubeset 400. Tubeset 400 may be connectedto perfusion apparatus 1, shown in other detail in FIG. 1, or to anorgan transporter or an organ diagnostic apparatus. In this manner,cassette 65 may be moved between various apparatus without jeopardizingthe sterility of the interior of cassette 65. Cassette 65 may be made ofa sufficiently durable material that it can withstand penetration andharsh impact. Cassette 65 may be provided with one or more lids,depicted in FIG. 6A as an inner lid 410 and an outer lid 420. As shownin FIG. 6A, the tube set may be connected to a bubble trap device BT.Such a bubble trap device is described in detail in a U.S. PatentApplication Publication No. US 2004-0221719, the disclosure of which ishereby incorporated by reference herein in its entirety.

The cassette 65 is a portable device. As such, the one or more lids 410,420 can create a substantially airtight seal with the cassette 65. Thisair tight seal can create a pressure difference between the inside andoutside of cassette 65. Pressure sensors that control perfusion of theorgan may be referenced to the atmospheric pressure. In suchembodiments, it is desirable that the air space around the organ incassette 65 is maintained at atmospheric pressure. Accordingly, thecassette 65 may also include one or more devices for controlling thepressure. The devices for controlling pressure can be active or passivedevices such as valves or membranes. Membranes 415, 425, for example,may be located in the inner lid 410 and outer lid 420, respectively. Itshould be appreciated that any number of membranes may be located in thecassette 65, including in the cassette lids 410, 420. The membranes 415,425 are preferably hydrophobic membranes that help maintain an equalpressure between the inside and the outside of the cassette 65. Themembranes 415, 425, if sufficiently flexible, may remain impermeable orsubstantially impermeable to collapse. Alternatively, the membranes 415,425 may include filters that will let clean air pass in both directions.In such instances, the membranes 415, 425 should not allow dirt, dust,liquids and other contaminants to pass. The pore size in the filters ofthe membranes 415, 425 may be selected to prevent bacteria from passing.The presence of the membranes 415, 425, and corresponding filters, helpmaintain the sterility of the system.

The lids 410, 420 may be removable or may be hinged or otherwiseconnected to the body of cassette 65. Clasp 405, for example, mayprovide a mechanism to secure lids 410, 420 to the top of cassette 65.Clasp 405 may additionally be configured with a lock to provide furthersecurity and stability. A biopsy and/or venting port 430 may be includedin inner lid 410, or in both inner lid 410 and outer lid 420. Port 430may provide access to the organ 60 to allow for additional diagnosis ofthe organ 60 with minimal disturbance of the organ 60. Cassette 65 mayalso have an overflow trough 440 (shown in FIG. 6B as a channel presentin the top of cassette 65). When lids 410, 420 are secured on cassette65, overflow trough 440 may provide a region to check to determine ifthe inner seal is leaking. Perfusate may be poured into and out ofcassette 65 and may be drained from cassette 65 through a stopcock orremovable plug.

Cassette 65 and/or lids 410, 420 may be constructed of an opticallytransparent material to allow for viewing of the interior of cassette 65and monitoring of the organ 60 and to allow for video images orphotographs to be taken of the organ 60. A perfusion apparatus orcassette 65 may be wired and fitted with a video camera or aphotographic camera, digital or otherwise, to record the progress andstatus of the organ 60. Captured images may be made available over acomputer network such as a local area network or the Internet to providefor additional data analysis and remote monitoring. Cassette 65 may alsobe provided with a tag that would signal, e.g., through a bar code,magnetism, radio frequency, or other means, the location of the cassette65, that the cassette 65 is in an apparatus 1, and/or the identity ofthe organ 60 to perfusion, storage, diagnostic and/or transportapparatus. Cassette 65 may be sterile packaged and/or may be packaged orsold as a single-use disposable cassette, such as in a peel-open pouch.A single-use package containing cassette 65 may also include tubeset 400and/or tube frame 200, discussed further below.

Cassette 65 may be configured such that it may be removed from an organperfusion apparatus and transported to another organ perfusion and/ordiagnostic apparatus in a portable transporter apparatus as describedherein or, for example, a conventional cooler or a portable containersuch as that disclosed in U.S. Pat. No. 6,209,343, or U.S. Pat. No.5,586,438 to Fahy, the disclosures of which are hereby incorporated byreference herein in their entirety.

In various exemplary embodiments, when transported, the organ 60 may bedisposed on the organ supporting surface 66 and the cassette 65 may beenclosed in a sterile bag 69, as shown, for example, in FIG. 4A. Whenthe organ is perfused with medical fluid, effluent medical fluidcollects in the bag 69 to form an organ bath. Alternatively, cassette 65may be formed with a fluid tight lower portion in which effluent medicalfluid may collect, or effluent medical fluid may collect in anothercompartment of an organ storage, transporter, perfusion and/ordiagnostic apparatus, to form an organ bath. The bag 69 would preferablybe removed prior to inserting the cassette 65 into an organ storage,transporter, perfusion and/or diagnostic apparatus. Further, where aplurality of organs 60 are to be perfused, multiple organ compartmentsmay be provided.

FIG. 7 shows an external view of an embodiment of a transporter 1900.The transporter 1900 of FIG. 7 has a stable base to facilitatemaintaining an upright position and handles 1910 for carryingtransporter 1900. Transporter 1900 may also be fitted with a shoulderstrap and/or wheels to assist in carrying transporter 1900. A controlpanel 1920 may be provided. Control panel 1920 may displaycharacteristics, such as, but not limited to, infusion pressure,attachment of the tube frame, power on/off, error or fault conditions,flow rate, flow resistance, infusion temperature, bath temperature,pumping time, battery charge, temperature profile (maximums andminimums), cover open or closed, history log or graph, and additionalstatus details and messages, some or all of which may be furthertransmittable to a remote location for data storage and/or analysis.Flow and pressure sensors or transducers in transporter 1900 may beprovided to monitor various organ characteristics including pumppressure and vascular resistance of an organ, which can be stored incomputer memory to allow for analysis of, for example, vascularresistance history, as well as to detect faults in the apparatus, suchas elevated pressure.

Transporter 1900 may include latches 1930 that require positive useraction to open, thus avoiding the possibility that transporter 1900inadvertently opens during transport. Latches 1930 may hold top 1940 inplace on transporter 1900 in FIG. 7. Top 1940 or a portion thereof maybe constructed with an optically transparent material to provide forviewing of the cassette and organ perfusion status. Transporter 1900 maybe configured with a cover open detector that monitors and displayswhether the cover is open or closed. Transporter 1900 may be configuredwith an insulating exterior of various thicknesses to allow the user toconfigure or select an appropriate transporter 1900 for varying extentsand distances of transport. In embodiments, compartment 1950 may beprovided to hold patient and organ data such as charts, testingsupplies, additional batteries, hand-held computing devices and/orconfigured with means for displaying a UNOS label and/or identificationand return shipping information.

FIG. 8 is a cross-section view of a transporter 1900. Transporter 1900may be fitted with a conformed cassette 65 and include pump 2010.Cassette 65 may preferably be placed into or taken out of transporter1900 without disconnecting tubeset 400 from cassette 65, thusmaintaining sterility of the organ. In embodiments, sensors intransporter 1900 can detect the presence of cassette 65 in transporter1900, and, depending on the sensors, can read the organ identity from abarcode or radio frequency or other “smart” tag that may be attached, orintegral, to cassette 65. This can allow for automated identificationand tracking of the organ in the cassette 65, and helps to monitor andcontrol the chain of custody. A global positioning system receiver maybe added to transporter 1900 and/or cassette 65 to facilitate trackingof the organ. Transporter 1900 may be interfaceable to a computernetwork by hardwire connection to a local area network or by wirelesscommunication, for example, while in transit. This interface may allowdata such as perfusion parameters, vascular resistance, and organidentification, and transporter 1900 and cassette 65 location, to betracked and displayed in real-time or captured for future analysis.

Transporter 1900 may contain a filter 2020 to remove sediment and otherparticulate matter from the perfusate to prevent clogging of theapparatus or the organ. Transporter 1900 may also contains batteries2030, which may be located at the bottom of transporter 1900 or beneathpump 2010 or at any other location that provides easy access to changebatteries 2030. Transporter 1900 may also provide an additional storagespace 2040, for example, at the bottom of transporter 1900, for powercords, batteries and other accessories. Transporter 1900 may alsoinclude a power port for a DC hookup, e.g., to a vehicle such as anautomobile or airplane, and/or for an AC hookup.

As shown in FIG. 8, the cassette wall CW of cassette 65 is preferablyconfigured to mate with a corresponding configuration of innertransporter wall TW of the temperature 1900 to maximize contact, andfacilitate heat transfer, as discussed in more detail below.

FIG. 9 is an alternate cross-sectional view of transporter 1900. In FIG.9, the transporter 1900 may have an outer enclosure 2310 which may, forexample, be constructed of metal, plastic or synthetic resin that issufficiently strong to withstand penetration and impact. Transporter1900 may contain insulation 2320, such as a thermal insulation made of,for example, glass wool or expanded polystyrene. Insulation 2320 may beof various thicknesses. Transporter 1900 may be cooled by coolant 2110,which may be, e.g., an ice and water bath or a cryogenic material. Inembodiments using cryogenic materials, the design should be such thatorgan freezing is prevented. Transporter 1900 may be configured to holdvarious amounts of coolant. An ice and water bath is preferable becauseit is inexpensive and generally cannot get cold enough to freeze theorgan. The level of coolant 2110 may, for example, be viewed through atransparent region of transporter 1900 or be automatically detected andmonitored by a sensor. Coolant 2110 may be replaced without stoppingperfusion or removing cassette 65 from transporter 1900. Coolant 2110may be maintained in a fluid-tight compartment 2115 of transporter 1900.An inner transporter wall TW as shown in FIG. 8, may be interposedbetween the coolant 2110 and cassette wall CW in the apparatus of FIG.9. Compartment 2115 preferably prevents the loss of coolant 2110 in theevent transporter 1900 is tipped or inverted. Heat is conducted from thewalls of the cassette 65 into coolant 2110 enabling control within thedesired temperature range. Coolant 2110 may provide a failsafe coolingmechanism where transporter 1900 automatically reverts to cold storagein the case of power loss or electrical or computer malfunction.Transporter 1900 may also be configured with a heater to raise thetemperature of the perfusate.

An electronics module 2335 may also be provided in transporter 1900.Electronics module 2335 may be cooled by vented air convection 2370, andmay further be cooled by a fan. Preferably, electronic module 2335 ispositioned separate from the perfusion tubes to prevent the perfusatefrom wetting electronics module 2335 and to avoid adding extraneous heatfrom electronics module 2335 to the perfusate. Transporter 1900 mayinclude a pump 2010 that provides pressure to perfusate tubing 2360(e.g., of tube set 400) to deliver perfusate 2340 to organ 60. Pressuresensor P1 may be provided on perfusate tubing 2360 to relay conditionstherein to the microprocessor 150, shown in FIG. 3. Transporter 1900 maybe used to perfuse various organs such as a kidney, heart, liver, smallintestine and lung. Transporter 1900 and cassette 65 may accommodatevarious amounts to perfusate 2340.

Cassette 65 and transporter 1900 may be constructed to fit or mate suchthat efficient heat transfer is enabled. The transporter 1900 may relyon conduction to move heat from the cassette 65 to coolant 2110contained in compartment 2115. This movement of heat allows thetransporter 1900 to maintain a desired temperature of the perfusionsolution. The geometric elements of cassette 65 and transporter 1900 maybe configured such that when cassette 65 is placed within transporter1900, the contact area between cassette 65 and transporter 1900 is aslarge as possible and they are secured for transport.

Pump 2010, which may be a peristaltic pump, or any type of controllablepump, may be used to move fluid throughout the infusion circuit of, forexample, the organ perfusion apparatus of FIG. 2, the organ cassette 65of FIG. 6 a, and/or the organ transporter 1900 of FIG. 8, and into organ60.

It should be appreciated that the organ 60 may be any type of organ, akidney, liver, or pancreas, for example, and the organ may be from anyspecies, such as a human or other animal.

In a flow path for perfusate (infusion circuit), immediately preceding,or within, organ 60, may lie a pressure sensor P1, which can sense thepressure of fluid flow at the position before the fluid enters, ordispersed in, organ 60. As fluid is moved throughout the infusioncircuit, organ 60 provides resistance. Pressure sensor P1 detects thepressure that the organ 60 creates by this resistance as the fluid movesthrough it. At a position after organ 60, there is little pressure, asthe fluid typically flows out of the organ 60 freely and into an organbath.

The liver is a three-terminal device where flows enter separately intothe portal vein and hepatic artery and exit combined through the hepaticvein. FIG. 10 is a schematic view of the relationship between thepressure and flow of the fluid in the hepatic artery and portal vein inan exemplary embodiment of the perfusion apparatus in the liver. In FIG.10, Fv is the flow of the fluid out of the liver in the hepatic vein.Fpv is the flow of fluid in the portal vein. Fha is the flow of thefluid in the hepatic artery. In exemplary embodiments, these valuessatisfy the relationship Fv=Fpv+Fha. Ppv is the pressure of fluid in theportal vein. Pha is the pressure of the fluid in the hepatic artery.

In a liver perfusion apparatus, one machine (comprising pump, valves,sensors, tubing, etc.) may supply fluid to the portal vein and aseparate or related or combined machine may supply the hepatic artery(for simplicity, but without limitation, this machine or machines willbe referred to herein as if they are separate “machines.”)

As Pha increases, a threshold is reached at which Fpv begins to decline(f(Ppv, Pha)). After that point, if Pha continues to be increased, Fpvwill decline in response. This phenomena is referred to as “flowcompetition.” Fpv can decline to zero during flow competition, resultingin a condition of flow extinction in the portal vein. Reducing Pha willtend to reverse this effect, although there will exist an amount ofhysteresis.

FIG. 11 illustrates a schematic view of an exemplary control algorithmunit 3000 for use in operating organ perfusion machines such as thosedescribed herein and is particularly adapted to provided cooperativecontrol of the flow of fluid to a plurality of input vessels in multipleinput vessel organs such as the liver. Control algorithm unit 3000 mayinclude a sensor interface 3100, a pressure/determination unit 3200, acontroller 3300 one or more storage units 3400, a data interface 3500,and a user interface 3600, all connected by a data/control buss 3700. Itwill be understood that the control algorithm unit 3000 may containother units as appropriate for controlling the perfusion methodsdescribed herein. Further, control algorithm unit 3000 may be adaptableto, and may operate in conjunction with, any of the devices or apparatusenvisioned by this disclosure, including, but not limited to, an organcassette, an organ perfusion apparatus, or an organ storage deviceand/or an organ transporter.

The sensor interface 3100 may provide a path by which sensors (notshown) for sensing parameters of the fluid flow in the vessels of anorgan 60 may transmit measurement data regarding sensed parameters tothe control algorithm unit 3000. Such parameters may include, forexample, the pressure and flow of the fluid flowing in one or morevessels perfusing the organ. Further, the sensor interface 3000 may be adevice in the form of, for example, a microprocessor for interfacingbetween sensors of the apparatus in which the control algorithm unit3000 is installed, or with which it is operating and a determinationunit 3200, or may include integral sensors in the unit 3100 itself forsensing one or more parameters.

In exemplary embodiments, the sensor interface 3100 may, either directlyor indirectly, sense the pressure and flow of fluids flowing in thehepatic artery and portal vein of a liver. The sensor interface 3100 mayalso sense the pressure and flow of fluids exiting the liver through thehepatic vein. The data may be used, for example, by the determinationunit 3200 for comparison to the data prescribed by the therapeuticwindow or may be related to other parameters of vitality. Comparativeparameter data regarding either therapeutic windows or the sensedparameters, or otherwise, may be stored in, or accessible via, forexample, the one or more storage units 3400, via the data interface 3500for connecting to an external data source, or via some user inputprovided at the user interface 3600, which may be configured, forexample, as a graphical user interface.

The control algorithm unit 3000 may comprise a determination unit 3200.The determination unit 3200 may compare the metrics of a parametersensed by the sensors accessible with sensor interface 3100 to thepre-set boundaries of the therapeutic window that may be available fromthe several data sources discussed above. The determination unit 3200may compare the sensed values to the therapeutic window and determinewhether the sensed parameter is within the therapeutic window. Thedetermination unit 3200 may be, for example, a microprocessor.

In exemplary embodiments, the determination unit 3200 may compare thepressure and flow of fluid flowing in the hepatic artery and fluidflowing in the portal vein of the liver. It will be understood that thedetermination unit may make value to pre-set value comparisons, but alsomay be capable of higher-order valuations as needed by, for example, thecomplexity of the organ or the number of parameters being compared.

Based on the comparisons, the determination unit 3200 may determinewhether the perfusion apparatus with which the unit 3000 is associatedshould be operated in an individual or cooperative capacity with regardto controlling the flow of fluid flowing in a plurality of vessels in anorgan. For example, the determination unit 3200 may determine that aflow of fluid flowing in the portal vein falls outside the therapeuticwindow. In such an instance, the determination unit 3200 may indicate tothe controller 3300 that the perfusion apparatus should be operated in acooperative mode to manage fluid pressure and flow for the fluid flowingin both the hepatic artery and the portal vein in an effort to controlthe parameters in the hepatic artery in a manner to influence the flowof the fluid flowing in the portal vein back to within the therapeuticwindow.

The control algorithm unit 3000 may comprise a separate or integratedcontroller 3300 or control algorithm to execute the control functions ofthe unit 3000. The controller 3300 may implement an algorithm based onthe determination made by the determination unit 3200. The controller3300 may control the perfusion apparatus with which the unit 3000 isassociated, or it may control individual units or devices within thatapparatus. The controller 3300 may execute control to manipulate thefunctions of the apparatus to alter the parameters of the fluid flowingin the vessels. For example, in the liver, the controller 3300 maydecrease the pressure of the fluid perfused by the apparatus perfusingthe liver through the hepatic artery to cooperatively affect the flow ofthe fluid flowing in the portal vein. In this exemplary manner, thecontroller 3300 is able to manage a single or a plurality of units in anapparatus perfusing an organ, such as the liver, through a plurality ofvessels by any one of, or combination of, starting, stopping, increasingor decreasing a function of the parameter of a fluid flowing through avessel as delivered by the perfusion apparatus

The unit 3000 may comprise one or more storage units 3400. The one ormore storage units 3400 may operate in several capacities within theunit 3000 or outside the unit 3000 in the form of auxiliary storagemedia such as, for example, a computer readable storage medium with acompatible reading device. As shown in FIG. 11, in exemplaryembodiments, one or more storage units 3400 may store values sensed bythe sensor interface 3100 to be later provided to the determination unit3200 or the controller 3300. The storage unit may also be capable ofreceiving input from the determination unit 3200 regarding, for example,determinations made but not to be applied immediately, but rather storedfor a time and then sent to the controller 3300.

A control algorithm for coordinating the control of the machines withina single perfusion apparatus, such as a liver perfusion apparatus, willnow be described.

The combination of flow and pressure in a vessel generally describe atherapeutic window for organ perfusion. If the flow or pressure is toohigh, the organ may be damaged; if the flow or pressure is too low, thenthe therapeutic benefits of perfusion are not realized at all, or asfully as desired. The therapeutic window is empirical, and may beestablished within an organ perfusion apparatus by a user ormanufacturer. For example, the user may set a target value that eachmachine may attempt to maintain while maintaining a parameter accordingto a preset therapeutic value. For example, each machine may attempt tomaintain a target pressure while maintaining flow above a therapeuticminimum. The organ perfusion apparatus is directed to maintainingpressure and flow within the therapeutic window.

For comparative reference, generally organs, such as kidneys, forexample, are considered two-terminal devices. In a kidney, flow entersthe renal artery and exits the renal vein. Flow through the kidney canbe increased or decreased by increasing or decreasing the fluid pressuregoing into the renal artery. During perfusion, higher fluid pressure atthe entrance to the renal artery delivers higher flow into the renalartery. Because the relationship between pressure and flow changesduring perfusion as blood vessels tighten and loosen, an automaticcontroller within a kidney perfusion apparatus continually measures andadjusts pressure and flow up or down to stay within the therapeuticwindow. This mode of controller operation can be considered the Linearmode.

During relatively low flow conditions, such as may be encountered at thestart of perfusion when the blood vessels are constricted in a liver,the flow into the portal vein and hepatic artery of a liver may becontrolled independently using the Linear mode (as described for thekidney above). The pressure and flow of each vessel may be raised andlowered independently to maintain operation within appropriatetherapeutic windows.

As the flow into the hepatic artery increases, a threshold is reached(which varies from liver to liver), at which further increase in hepaticartery flow may result in reduction of portal vein flow. This is flowcompetition. Flow competition may increase to a degree that it drivesthe parameter for the fluid flowing in the portal vein below thetherapeutic minimum even though the portal vein pressure has reached thetherapeutic maximum. At this point, further control of the portal veinwithin the therapeutic window cannot be maintained by adjusting theportal vein machine alone. A perfusion apparatus including the systemsand methods according to this disclosure may detect such conditions andthe deformentation may be made that a controller should direct theperfusion apparatus to a Cooperative mode of operation, with a goal ofcoordinated maintenance of both hepatic artery and portal vein pressureand flow within appropriate therapeutic windows.

During Cooperative mode operation, the controller 3300 may control thehepatic artery flow and initially reduce this flow until the portal veinflow is detected to increase back into the therapeutic window. Once bothsets of pressure and flow conditions are reestablished within thetherapeutic window, then revised parameters may be set by the controller3300, which are within the therapeutic window at a sufficient value foreach parameter to attempt to maintain stable perfusion in the apparatusand organ. With new parameters established, the controller 3300 mayreturn to operating in the Linear mode, and new parameter settings maybe, for example, stored in one or more storage units 3400. Furthermore,the user may be notified regarding the establishment of Cooperative modeoperation and may display the new parameter settings.

In conditions where flow competition is detected, the competition can beso sever that it arrests flow in, for example, the portal vein andreduces it to zero. In such instances, the controller 3300 may operateto momentarily interrupt flow completely in the hepatic artery allowingportal vein flow to be reestablished, and, once portal vein flow isdetected, to restart either Linear mode or Cooperative mode operationmay be continued, where hepatic artery flow is restarted, preferentiallyafter starting the portal vein flow under most circumstances (forexample after bubble purge or fault recovery or user-directed flowstart-up).

It should be recognized that leaks in a fluid circuit, occluded vessels,improperly cannulated vessels, and impact forces to the apparatus maychange flow and pressure to an extent to be outside the therapeuticwindow. These fault conditions generally cause extreme transientsoutside the therapeutic window such that the fault conditions may bedifferentiated from flow competition. The controller 3300 may make thisdifferentiation to determine whether to implement Cooperative mode,including recovery from portal vein extinction, or error handling, andmake corrections appropriately.

With reference to FIG. 12, the following example control algorithm isprovided.

In step 4100, pressure and flow of a therapeutic window are establishedwith user settings, in apparatus pre-sets, as stored parameters, and/orcombinations thereof. A user or computer sets a desired systolicpressure and/or flow, which is the pressure and flow of the fluid supplybefore entering the organ at pressure sensor P1, as discussed above. Aperistaltic pump, for example, or any other type of controllable pump,may begin operation at step 4100.

In step 4200, the perfusion apparatus is started and operation is begun.The perfusion process is started, for example, by user pressing anINFUSE button. In step 4300, infusion of portal vein and hepatic arteryflow is operated by the perfusion apparatus in an initial, likely,Linear mode. In exemplary embodiments, it is preferable to sequence aportal vein supply machine or pump to start before the hepatic arterysupply machine or pump to reduce the risk of flow extinction due to flowcompetition at start-up.

In steps 4400, 4425, 4450 and 4475, pressure sensor P1, and thecorresponding flow sensor, are queried to determine whether the pressureand flow of the fluid flowing in the hepatic artery and portal vein arewithin the respective therapeutic windows. If the portal vein or hepaticartery pressure or flow cannot be maintained within the respectivetherapeutic window, the pressure and flow environments are analyzed instep 4500 to identify the severity of causal conditions to determinewhether the perfusion apparatus will go to, for example, Cooperativemode (step 4600), Error handling mode (step 4700), or Flow extinctionrecovery mode (step 4800).

In step 4600, the perfusion apparatus goes to Cooperative mode. InCooperative mode, a controller may reduce hepatic artery flow untilportal vein flow returns to within the therapeutic window. Then, in step4650, the controller establishes a new hepatic artery goal pressure thatis well within the therapeutic window for all parameters. After theperfusion apparatus stabilizes within the parameter(s) in thetherapeutic window, the controller may cause the apparatus to returnoperation, in perfusion step 4300, to a Linear mode.

In step 4700, the controller may drive the perfusion apparatus to anError handling mode. In the Error handling mode, the controller maydetermine if conditions suggest a fault condition such as, for example,occlusion, leak, over-pressure, or under-pressure, and then activates analarm, coincident with implementing a stored or otherwise directed errorhandling and/or recovery algorithms. Based on the detected error, thecontroller may appropriately reset the perfusion apparatus, such as by auser, or automatically, in step 4750 and the direct the control methodto return to step 4200 to restart.

In step 4800, the controller may detect actual or impending conditionsof zero flow in the portal vein and drive the perfusion apparatusaccording to a Flow extinction mode. In an exemplary Flow extinctionmode, the controller stops the hepatic artery supply machine, or bothmachines, in step 4850. Then, the controller operates to start portalvein flow to a set level within the therapeutic window in step 4200.After starting portal vein flow, the controller restarts hepatic arteryflow. The controller then returns the perfusion apparatus to eitherLinear mode (step 4200) or, ultimately, Cooperative mode (step 4600)depending on the conditions of the pressure and flow environmentrelative to the therapeutic window.

All patents, patent applications, scientific articles and other sourcesand references cited herein are explicitly incorporated by referenceherein for the full extent of their teachings as if set forth in theirentirety explicitly in this application.

It should be understood that the foregoing disclosure emphasizes certainspecific embodiments of the invention and that modifications oralternatives equivalent thereto are within the spirit and scope of theinvention.

1. A method for controlling at least one pump in a perfusion apparatusfor delivering a fluid to at least one organ through a plurality ofvessels for maintaining the viability of the at least one organ, themethod comprising: supplying a fluid to a first vessel of an organ andto a second vessel of an organ; measuring a first parameter of the fluidflowing in the first vessel and a second parameter of the fluid flowingin the second vessel; and executing direct control of the secondparameter of the fluid flowing in the second vessel to influence thefirst parameter of the fluid flowing in the first vessel.
 2. The methodof claim 1, further comprising: detecting that the first parameter ofthe fluid flowing in the first vessel falls outside of a predeterminedrange for the first parameter, wherein the direct control of the secondparameter of the fluid flowing in the second vessel is executed tocooperatively return the first parameter to within the predeterminedrange.
 3. The method of claim 2, further comprising executing directcontrol of the first parameter of the fluid flowing in the first vesselindependently when the first parameter of the fluid in the first vesselis within the predetermined range for the first parameter.
 4. The methodof claim 2, further comprising setting operational goals for the firstand second parameters within predetermined ranges.
 5. The method ofclaim 4, wherein the operational goals are reset when the parameter ofthe fluid flowing in the first vessel is returned to within thepredetermined range.
 6. The method of claim 2, wherein the predeterminedrange is at least one of received from a user, recovered from a storageunit or preset in the apparatus.
 7. The method of claim 1, furthercomprising: detecting that the fluid has stopped flowing in the firstvessel, wherein the executing direct control of the second parameter ofthe fluid flowing in the second vessel comprises stopping the flow ofthe fluid in the second vessel to enable restarting flow of the fluid inthe first vessel.
 8. The method of claim 7, further comprising:executing direct control of the fluid in the first vessel to restartflow; and detecting flow of the fluid in the first vessel, wherein theexecuting direct control of the second parameter of the fluid flowing inthe second vessel comprises restarting the flow of the fluid in thesecond vessel.
 9. The method of claim 8, wherein fluid flow is restartedin the second vessel only after flow is detected in the first vessel.10. The method of claim 1, wherein at least one of the first parameterand the second parameter is at least one of a pressure of the fluid or aflow of the fluid flowing in the respective vessel.
 11. The method ofclaim 1, wherein the executing direct control of the second parametercomprises adjusting a pressure of the fluid flowing in the secondvessel.
 12. The method of claim 11, wherein decreasing the pressure ofthe fluid flowing in the second vessel increases the flow of the fluidflowing in the first vessel.
 13. The method of claim 1, wherein theorgan is a liver.
 14. The method of claim 13, wherein the first vesselis a portal vein of the liver and the second vessel is a hepatic arteryof the liver.
 15. The method of claim 1, wherein at least one of thefirst parameter and the second parameter is determined at a locationjust upstream of an entrance of the fluid into the respective vessel inthe organ.
 16. The method of claim 1, wherein the method is used tocontrol a fluid supply pump connected to at least one of an organperfusion and storage device, an organ transport device, or an organcassette that is transferable between an organ perfusion and storagedevice and an organ transport device.
 17. The method of claim 16,wherein the pump is at least one of a peristaltic pump or a roller pump.18. A computer readable storage medium on which is recorded a programfor causing a computer to execute the method of claim
 1. 19. A controlsystem for at least one pump for delivering a fluid in a perfusionapparatus to at least one organ through a plurality of vessels formaintaining the viability of the at least one organ, the systemcomprising: a pump that supplies a fluid to a first vessel of an organand to a second vessel of an organ; a sensor interface that receivessensor input that measures a first parameter of the fluid flowing in thefirst vessel and a second parameter of the fluid flowing in the secondvessel; and a controller that directly controls the second parameter ofthe fluid flowing in the second vessel to influence the first parameterof the fluid flowing in the first vessel.
 20. The system of claim 19,further comprising a determination unit that compares the measured firstparameter to a predetermined range for the measured first parameter todetermine if the measured first parameter falls outside thepredetermined range, the determination unit causing the controller tocontrol the second parameter of the fluid flowing in the second vesselcooperatively to return the first parameter to within the predeterminedrange.
 21. The system of claim 20, wherein the controller directlycontrols the first parameter of the fluid flowing in the first vesselindependently when the first parameter of the fluid in the first vesselis within the predetermined range.
 22. The system of claim 21, whereinthe controller sets operational goals for the first and secondparameters within predetermined ranges.
 23. The system of claim 22,wherein the controller resets the operational goals when the parameterof the fluid flowing in the first vessel is returned to within thepredetermined range.
 24. The system of claim 20, further comprising astorage unit for storing the predetermined range, wherein thepredetermined range is at least one of received from a user via a userinterface, received via a data interface or preset in the system. 25.The system of claim 20, wherein the determination unit detects that thefluid has stopped flowing in the first vessel, and causes the controllerto stop the fluid flowing in the second vessel to enable restarting flowof the fluid in the first vessel.
 26. The system of claim 25, wherein:the controller directly controls the fluid in the first vessel torestart the flow, the determination unit detects flow of the fluid inthe first vessel, and the controller restarts the flow of the fluid inthe second vessel.
 27. The system of claim 26, wherein fluid flow isrestarted in the second vessel only after flow is detected in the firstvessel.
 28. The system of claim 19, wherein at least one of the firstparameter and the second parameter is at least one of a pressure of thefluid or a flow of the fluid flowing in the respective vessel.
 29. Thesystem of claim 23, wherein the operational goals are displayed to theuser and changes to the operational goals are audibly or visiblyannounced via a user interface.